A multicenter, double-blind, randomized controlled clinical trial comparing ergometrine with oxytocin and oxytocin alone for prevention of postpartum hemorrhage at cesarean section / 中华妇产科杂志

Objective:To compare oxytocin combined with ergometrine with oxytocin alone in terms of primary prophylaxis for postpartum hemorrhage (PPH) at the time of cesarean section (CS).Methods:This was a multicenter double-blind randomized controlled interventional study comparing ergometrine combined with oxytocin and oxytocin alone administered at CS. From December 2018 to November 2019, a total of 298 parturients were enrolled in 16 hospitals nationwide. They were randomly divided into experimental group (ergometrine intra-myometrial injection following oxytocin intravenously; 148 cases) and control group (oxytocin intra-myometrial injection following oxytocin intravenously; 150 cases) according to 1∶1 random allocation. The following indexes were compared between the two groups: (1) main index: blood loss 2 hours (h) after delivery; (2) secondary indicators: postpartum blood loss at 6 h and 24 h, placental retention time, incidence of PPH, the proportion of additional use of uterine contraction drugs, hemostatic drugs or other hemostatic measures at 2 h and 24 h after delivery, the proportion requiring blood transfusion, and the proportion of prolonged hospital stay due to poor uterine involution; (3) safety indicators: nausea, vomiting, dizziness and other adverse reactions, and blood pressure at each time point of administration.Results:(1) The blood loss at 2 h after delivery in the experimental group [(402±18) ml] was less than that in the control group [(505±18) ml], and the difference was statistically significant ( P<0.05). (2) The blood loss at 6 h and 24 h after delivery in the experimental group were less than those in the control group, and the differences were statistically significant (all P<0.05). There were no significant differences between the two groups in the incidence of PPH, the proportion of additional use of uterine contraction drugs, hemostatic drugs or other hemostatic measures at 2 h and 24 h after delivery, the proportion requiring blood transfusion, and the proportion of prolonged hospital stay due to poor uterine involution (all P>0.05). (3) Adverse reactions occurred in 2 cases (1.4%, 2/148) in the experimental group and 1 case (0.7%, 1/150) in the control group. There was no significant difference between the two groups ( P>0.05). The systolic blood pressure within 2.0 h and diastolic blood pressure within 1.5 h of drug administration in the experimental group were higher than those in the control group, and the differences were statistically significant ( P<0.05), but the blood pressure of the two groups were in the normal range. Conclusion:The use of ergometrine injection in CS could reduce the amount of PPH, which is safe and feasible.

Clinical effect of ergometrine maleate injection combined with posterior pituitary injection in the treatment of postpartum hemorrhage / 中国基层医药

Objective@#To investigate the clinical effect of ergometrine maleate injection combined with posterior pituitary injection in the treatment of postpartum hemorrhage.@*Methods@#From April 2016 to July 2018, 68 patients with postpartum hemorrhage treated in the Maternal and Child Health Care Hospital of Tongxiang were randomly divided into two groups according to the random number table, with 34 patients in each group.The control group was treated with posterior pituitary injection.The observation group was treated with ergometrine maleate injection combined with posterior pituitary injection.The bleeding volume at different time points after treatment was compared between the two groups.The hemostasis time, the duration of uterine contraction, the extent of uterine decline, the duration of lochia and serum cytokines levels before and after treatment were compared.@*Results@#The bleeding amount at 0.5 h, 2 h, 24 h after administration in the observation group were (76.82±15.40) mL, (112.34±18.73) mL and (196.70±20.60) mL, respectively, which were significantly lower than those in the control group[(147.38±17.65), (198.49±19.37) mL, (283.74±21.56) mL](t=17.565, 18.643, 17.020, all P<0.05). The duration of contractions[(3.83±1.40) h] and the extent of uterine decline[(6.25±0.93) cm] in the observation group were significantly better than those in the control group[(1.92±0.59) h, (4.65±0.66) cm], and the hemostasis time[(21.29±3.60)min] and duration of lochia[(17.19±4.67)d] in the observation group were significantly shorter than those in the control group[(42.28±3.85) min, (24.28±6.11) d](t=23.220, 7.331, 8.181, 5.376, all P<0.05). After treatment, the levels of nitrogen monoxide (NO)[(91.22±6.23) μmol/L], nitric oxide synthase (NOS)[(24.56±2.46) μmol/L], brain natriuretic peptide (BNP)[(46.81±5.10)ng/L] in the observation group were lower than those in the control group[(98.63±7.51) μmol/L, (30.92±3.95) μmol/L, (90.35±4.66)ng/L], and the differences were statistically significant (t=4.428, 7.969, 36.750, all P<0.05).@*Conclusion@#The effect of ergometrine maleate injection combined with posterior pituitary injection on postpartum hemorrhage is effective, which can effectively control the amount of bleeding, shorten the time of hemostasis and promote postpartum recovery.

Clinical effect of ergometrine maleate injection combined with posterior pituitary injection in the treatment of postpartum hemorrhage / 中国基层医药

Objective To investigate the clinical effect of ergometrine maleate injection combined with posterior pituitary injection in the treatment of postpartum hemorrhage.Methods From April 2016 to July 2018, 68 patients with postpartum hemorrhage treated in the Maternal and Child Health Care Hospital of Tongxiang were randomly divided into two groups according to the random number table ,with 34 patients in each group .The control group was treated with posterior pituitary injection .The observation group was treated with ergometrine maleate injection combined with posterior pituitary injection .The bleeding volume at different time points after treatment was compared between the two groups .The hemostasis time, the duration of uterine contraction , the extent of uterine decline,the duration of lochia and serum cytokines levels before and after treatment were compared .Results The bleeding amount at 0.5 h,2 h,24 h after administration in the observation group were (76.82 ±15.40) mL,(112.34 ± 18.73) mL and (196.70 ±20.60) mL,respectively,which were significantly lower than those in the control group [(147.38 ±17.65),(198.49 ±19.37) mL,(283.74 ±21.56) mL](t=17.565,18.643,17.020,all P<0.05). The duration of contractions[(3.83 ±1.40) h] and the extent of uterine decline[(6.25 ±0.93) cm] in the observation group were significantly better than those in the control group [(1.92 ±0.59) h,(4.65 ±0.66) cm],and the hemostasis time[(21.29 ±3.60) min] and duration of lochia [(17.19 ±4.67) d] in the observation group were significantly shorter than those in the control group[(42.28 ±3.85) min,(24.28 ±6.11) d](t=23.220,7.331, 8.181,5.376,all P<0.05).After treatment,the levels of nitrogen monoxide (NO)[(91.22 ±6.23)μmol/L], nitric oxide synthase (NOS)[(24.56 ±2.46)μmol/L],brain natriuretic peptide (BNP)[(46.81 ±5.10)ng/L] in the observation group were lower than those in the control group [(98.63 ±7.51)μmol/L,(30.92 ±3.95)μmol/L, (90.35 ±4.66)ng/L],and the differences were statistically significant (t=4.428,7.969,36.750,all P<0.05). Conclusion The effect of ergometrine maleate injection combined with posterior pituitary injection on postpartum hemorrhage is effective , which can effectively control the amount of bleeding , shorten the time of hemostasis and promote postpartum recovery .

Síndrome de vasoconstricción cerebral reversible (Call-Fleming) en el puerperio: reporte de un caso / Reversible cerebral vasoconstriction syndrome (Call-Fleming) during puerperium: A case report

Resumen ANTECEDENTES: El síndrome de vasoconstricción cerebral reversible, o síndrome de Call-Fleming, es una alteración excepcional, de origen incierto, caracterizada por cefalea, déficit neurológico y vasoespasmo cerebral reversible. En cuanto a su mecanismo fisiopatológico, se señala la relación con vasoconstricción segmentaria reversible en diferentes áreas cerebrales. CASO CLÍNICO: Paciente de 34 años, sin antecedentes de importancia para el padecimiento actual, de 40 semanas de embarazo, que ingresó a la unidad médica por actividad uterina irregular, con cifras tensionales de 120-80 mmHg, pulso 80 por minuto, frecuencia respiratoria 20 por minuto y temperatura de 37 ºC; la frecuencia cardiaca fetal fue de 140 latidos por minuto. Al no existir progresión del trabajo de parto, se decidió su interrupción por vía abdominal y se obtuvo un recién nacido sano. Durante el puerperio inmediato, después de la administración de ergonovina, la paciente manifestó hipertensión arterial y cefalea súbita relacionada con déficit neurológico, por lo que requirió el ingreso a la unidad de cuidados intensivos hasta su estabilización. Se estableció el diagnóstico de cefalea tipo "trueno"; la tomografía computada no mostró alteraciones aparentes, el líquido cefalorraquídeo fue claro, con concentración leucocitaria de 10 mm3 y eritrocitaria de 6 mm3. CONCLUSIÓN: El síndrome de Call-Fleming es una alteración poco frecuente durante el embarazo y puerperio; por tanto, es importante conocer, identificar y establecer el diagnóstico diferencial de la enfermedad.

Abstract BACKGROUND: Reversible cerebral vasoconstriction syndrome, or Call-Fleming syndrome, is an exceptional disorder of uncertain origin, characterized by headache, neurological deficit and reversible cerebral vasospasm. Regarding its physiopathological mechanism, the relationship with reversible segmental vasoconstriction in different brain areas has been postulated. CLINICAL CASE: A 34-year-old patient, in the 40 weeks pregnant, admitted to the medical unit due to irregular uterine activity, with blood pressure figures of 120/80 mmHg, pulse 80/min, respiratory rate 20/min and temperature of 37 ° C; the fetal heart rate was 140 beats per minute. Due to the non-progression of labor, it was decided to interrupt it by abdominal route, from which a healthy newborn was obtained. During the immediate puerperium, after the administration of ergonovine, the patient manifested arterial hypertension and sudden headache related to neurological deficit, for which she required admission to the Intensive Care Unit until stabilization. The diagnosis of "thunder" type headache was established; the computed tomography showed no apparent alterations, the cerebrospinal fluid was clear, and leukocyte concentration of 10 mm3 and erythrocyte of 6 mm3. CONCLUSION: Call-Fleming syndrome is a rare condition during pregnancy and puerperium; therefore, it is important to know, identify and establish the differential diagnosis of the disease.

Ergonovine Stress Echocardiography for the Diagnosis of Vasospastic Angina and Its Prognostic Implications in 3,094 Consecutive Patients

BACKGROUND AND OBJECTIVES: Ergonovine stress echocardiography (ErgECHO) has been proposed as a noninvasive tool for the diagnosis of coronary vasospasm. However, concern over the safety of ErgECHO remains. This study was undertaken to investigate the safety and prognostic value of ErgECHO in a large population. METHODS: We studied 3,094 consecutive patients from a single-center registry who underwent ErgECHO from November 2002 to June 2009. Medical records, echocardiographic data, and laboratory findings obtained from follow-up periods were analyzed. RESULTS: The overall positive rate of ErgECHO was 8.6%. No procedure-related mortality or myocardial infarction (MI) occurred. Nineteen patients (0.6%) had transient symptomatic complications during ErgECHO including one who was successfully resuscitated. Cumulative major adverse cardiac events (MACEs) occurred in 14.0% and 5.1% of the patients with positive and negative ErgECHO results, respectively (p 220 mg/dL, and positive ErgECHO result itself were independent factors associated with MACEs. CONCLUSIONS: ErgECHO can be performed safely by experienced physicians and its positive result may be an independent risk factor for long-term adverse outcomes. It may also be an alternative tool to invasive ergonovine-provoked coronary angiography for the diagnosis of vasospastic angina.

Severe Mitral Regurgitation Due to Coronary Vasospasm, Confirmed by Ergonovine Echocardiography / 영남의대학술지

The common causes of organic mitral regurgitation (MR) include mitral valve prolapse (MVP) syndrome, rheumatic heart disease, and endocarditis. MR also occurs secondary to dilated cardiomyopathy and coronary artery disease. In acute severe MR, the hemodynamic overload often cannot be tolerated, and mitral valve repair or replacement must be performed immediately. We report herein a case of severe MR due to coronary vasospasm that was confirmed via ergonovine echocardiography in a 70-year-old man. He was scheduled to undergo mitral valve surgery, but it did not push through and he was put on medical therapy.

Does a Negative Ergonovine Provocation Test Truly Predict Freedom from Variant Angina?

Ergonovine provocation test is known to be very sensitive for diagnosing variant angina. The patient described in this study initially presented with atypical chest pain and underwent coronary angiography and ergonovine provocation tests, which were negative. The patient was subsequently prescribed a proton pump inhibitor and prokinetics for pain relief, but then presented with acute myocardial infarction and cardiogenic shock due to coronary artery vasospasm 5 years later. This case suggests that ergonovine provocation test generates false negative results, which can lead to unwanted outcomes. Even with a negative ergonovine provocation test, prescription of calcium channel blockers or nitrates should be considered in patients with a clinical history suggestive of variant angina.

Successful Recovery after Cardiac Arrest from Medically Intractable Coronary Spasm Induced by Ergonovine, Using Percutaneous Cardiopulmonary Support: A Case Report / 대한구급학회지

The ergonovine provocation test is often used in diagnosing variant angina. Most patients with an ergonovine-induced coronary artery spasm respond promptly to intracoronary nitroglycerin administration within 3 to 5 minutes. However, in a few patients ergonovine results in serious cardiovascular complications due to intractable coronary artery spasm. We report a case of a severe and medically intractable coronary spasm induced by ergonovine, followed by cardiac arrest. Aided by percutaneous cardiopulmonary support (PCPS) and mechanical ventilation, the patient could survive after four days of hospitalization despite a recurrent vasospasm. Recovery was largely attributed to full supportive care and the use of PCPS.

Cardiac arrest with pulmonary edema in a non-parturient after ergonovine administration recovered with extracorporeal membrane oxygenation: A case report / 대한마취과학회지

Ergonovine have been used for the prevention and treatment of postpartum or postabortion hemorrhage. Although this modality has been considered relatively safe in the obstetric patients, there were a few cardiac events associated with this drug in the post-delivery or post-abortion patients, especially in patients with cardiovascular risk factors. We experienced cardiac arrest in a non-parturient with no discernible risk factors. Although resuscitated, she also suffered from pulmonary edema with unstable hemodynamics and low oxygenation. To manage the patient, extracorporeal membrane oxygenation was used and she recovered successfully without cardiopulmonary complications. Therefore, we recommend that when ergonovine is chosen as a modality, special caution should be paid to the pulmonary events, as well as cardiac, especially when administered by intravenously even in patients with no cardiovascular risk factors. If cardiac events occur, extracorporeal membrane oxygenation or other measures, such as intra-aortic balloon pump can be helpful when conventional cardiopulmonary resuscitation is not effective.

A Case of Retrograde Dissection at the Right Sinus of Valsalva Resulted from Dissection of Right Coronary Artery during Ergonovine Test

Retrograde dissection extending into the sinus of Valsalva is a rare complication during percutaneous coronary intervention. That may occur due to trauma to the ostium from catheter manipulation and may sometimes require surgical repair. A 50-year old male patient was admitted because of chest pain. During catheterization of the right coronary artery (RCA) after ergonovine test, we encountered coronary artery dissection with retrograde dissection of right sinus of Valsalva leading to RCA occlusion. Then we placed coronary artery stent (4.0x24 mm Driver stent) at right coronary artery ostium and his coronary blood flow of RCA was recovered and no further extension of dissection was observed. Here, we present a case of acute myocardial infarction which resulted from the acute dissection of the sinus of Valsalva with obstruction of the right coronary ostia by intimal flap during angiography.

A Case of Variant Angina Developing Transient Collateral Circulation During Vasospasm

Variant angina is characterized by spontaneous episodes of angina, usually occurring in the morning and having ST segment elevation on the electrocardiogram. However, in the case presented here, vasospasm and angina was shown by ergonovine without ST elevation. The patient was a 60-year-old man who presented with a 2-year history of frequent chest pain. There were no abnormalities in coronary angiography. When ergonovine (100 microg) was injected, total occlusion of the proximal right coronary artery was seen, without ST elevation at the electrocardiogram. The cause was collateral from left anterior descending artery to distal right coronary artery at the left coronary angiography. Therefore, in a patient with variant angina without ST elevation, a transient collateral circulation during vasospasm should be considered.

A Case of Cardiac Arrest during Ergonovine Stress Echocardiography

Ergonovine stress echocardiography might be a feasible, accurate and safe procedure for the noninvasive diagnosis of coronary vasospasm. During ergonovine stress echocardiography, reversal of spasm is usually achieved by administration of nitroglycerin or nifedipine. However, we experienced a 61 year-old male case of cardiac arrest caused by multiple spasms and refractory of these medications during ergonovine stress echocardiography.

A Case of Cardiac Arrest during Ergonovine Stress Echocardiography

Ergonovine stress echocardiography might be a feasible, accurate and safe procedure for the noninvasive diagnosis of coronary vasospasm. During ergonovine stress echocardiography, reversal of spasm is usually achieved by administration of nitroglycerin or nifedipine. However, we experienced a 61 year-old male case of cardiac arrest caused by multiple spasms and refractory of these medications during ergonovine stress echocardiography.

Ergonovine Echocardiography for the Diagnosis of Vasospastic Angina

No abstract available.

Spontaneous Coronary Artery Dissection Manifested during Ergonovine Test and Treated with Intravascular Ultrasound Guided Stenting: A Case Report

Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute myocardial ischemia, which frequently presents as sudden death. The pathophysiology and treatment of SCAD have not been fully determined. Herein, a case of SCAD, manifesting as variant angina, which rapidly progressed during an ergonovine test, in which 3 drug-eluting stents were deployed using intravascular an ultrasound guidance, with an excellent immediate result, is reported.

Heart Arrest Caused by Ergonovine Stress Echocardiography

Recent reports have suggested that ergonovine stress echocardiography is a safe and accurate procedure for the diagnosis of coronary vasospasm. We experienced a case of heart arrest caused by ergonovine stress echocardiography. A 44 year-old female patient was referred to our emergency room for evaluation of chest pain. She had been admitted to another hospital complaining of chest pain and syncope. The finding of a coronary angiogram was normal and an ergonovine stress echocardiography was performed in order to diagnose the coronary vasospasm, which may be an etiologic mechanism in an unstable angina. After 250 microgram of ergonovine was administered intravenously, we suspected segmental wall motion abnormality (hypokinesia of the inferior wall). An additional dose (100 microgram) was administered to confirm the diagnosis. The patient complained of severe chest pain and dizziness. Segmental wall motion abnormalities progressed and heart arrest finally developed. She recovered following cardiopulmonary resuscitation and was discharged without complication.

Increased basal tone and hyperresponsiveness to acetylcholine and ergonovine in spasm related coronary arteries in patients with variant angina: basal coronary artery tone in patients with variant angina

In patients with variant angina, previous data have been inconclusive as to whether basal coronary artery tone is elevated at the spastic and non-spastic sites. Thus, the purpose of this study was to assess the basa coronary artery tone and the responsiveness to acetylcholine (Ach) and ergonovine (Erg) in patients with variant angina. We compared the basal coronary artery tone and the constrictive responses to Ach and Erg between 31 patients (Group 1) with variant angina in whom spasm was provoked by the low doses of Ach (intracoronary 20 micrograms) or Erg(intravenous 50 micrograms) and 35 patients (Group 2) provoked by higher doses of Ach (intracoronary 100 micrograms) or Erg (intravenous cumulative dose of 350 micrograms), and 26 control subjects. Patients with variant angina in whom spasm was provoked by low doses of Ach or Erg, had a higher incidence of mixed disease, multi-vessel spasm and higher disease activity. The basal coronary artery tone at the spastic and nonspastic sites of spasm related artery was significantly more elevated in Group 1 than that in Group 2 (44+/- 17 vs 14 +/- 11% and 26 +/- 14 vs 16 +/- 10% respectively, P< 0.05), but not in the nonspasm related artery, The magnitudes of vasoconstrictive responses to Ach and Erg at the nonspastic sites were also greater in Group 1 than those in Group 2 and the control groups (Ach; 40 +/- 20 vs 26+/- 11, 27 +/- 12%: Erg; 37 +/- 18 vs 12 +/- 8, 13 +/- 10% respectively, P< 0.05). However, the basal coronary artery tone was not elevated at the spastic and nonspastic sites in Group 2 compared to the in control subjects. These findings suggest that the basal coronary artery tone is increased in patients with variant angina with higher disease activity at the spastic sites and nonspastic sites of the spasm-related artery, and this may be related to the occurrence of coronary artery spasm.

Safety and Validity of Ergonovine Echocardiography before Coronary Angiography for Diagnosis of Coronary Vasospasm

BACKGROUND: Detection of left ventricular regional wall motion abnormality(RWMA) by 2 dimensional echocardiography during ergonovine provocation(Erg Echo) can be used for noninvasive diagnosis of coronary vasospasm(CVS). The aim of this study was to test the safety and diagnostic validity of Erg Echo as a screening test in patients with chest pain syndromes before coronary angiography was undertaken. METHODS: From Mar 1993 to Jun 1994, Erg Echo was performed in 80 consecutive patients (56 males) with chest pain syndromes suggestive of variant angina, after the confirmation of negative treadmill or normal stress myocardial perfusion scan using thallium 201. A bolus of ergonovine maleate was injectedd at 5min intervals up to total cumulative dosage of 0.35mg with echocardiographic montioring of the left ventricular wall motion. Twelve leads ECG was also recorded every 3min after each ergonovine injection. The positive criteria of the test was transient ST segment clevation or depression greater than 0.1mV in 12-leads ECG or development of RWMA. Coronary angiography was undertaken 2(+/-4) days after Erg Echo, and spasm provocation test with acetylcholine, or ergonovine was done in case of normal angiogram or luminal narrowing of less than 70%. The appearance of total or subtotal occlusion of a major coroary artery associated with ST segment elevation or depression on the ECG or chest pain, or both, was considered to be a manifestation of spasm. RESULTS: According to the invasive angiographic criteria, 56 patients revealed CVS ; CVS was ruled oup in 19 patients showing near normal angiogram with negative spasm provocation test and in 5 patients with restion high degree fixed stenosis(luminal narrowing of 97+/-4%). Erg Echo could diagnose CVS before the angiography with the sensitivity of 91%(51/56,95% confidence interval [CI] ; 84-98%) and the specificity of 88%(21/24,95% CI ; 75-100%). Of 53 patients showing RWMA in Erg Echo, 42%(22/53) revealed no significant changes in the simultaneously recorded ECG and characteristic ST elevation was recorded in only 38%(20/53). There was no case of myocardial infarction or fatal arrhythmia during Erg Echo. CONCLUSION: Erg Echo befor the coronary angiography is safe and can e utilized as a reliable diagnostic screening test of CVS in patients with negative tradmill or normal stess myocardial perfusion scan, This finding suggests that invasive coronary angiography can be avioded in selected patients for the diagnosis of vasospastic angina.

Intracoronary Ergonovine Provocation Test in Patients with Coronary Artery Spasm

BACKGROUND: Intravenous ergonovine and intracoronary acetylcholine tests have been used to induce coronary artery spasm, however, potential preblems with each test require a safer and more specific test. METHODS: To evaluate the usefulness of the intracoronary ergonovine provocation test in patients with coronary artery spasm, this test was performed in 83 patients(male 47, female 36) with normal or near-normal looking coronary angiography or insignificant lesion less than 50% in diameter after routine diagnostic coronary angiography. Ten micrograms of ergonovine maleate diluted in 1 ml of saline was injected into right coronary artery up to 2 times and into left coronary artery up to 3 times. Induction of coronary arterial narrowing more than 75% of luminal diameter with typical chest pain and/or ECG changes in two or more adjacent leads was considered as a positive test. RESULTS: Intracoronary ergonovine provocation tests were positive in 33 patients among 83 patients. In 24 patients, coronary artery spasm was induced in RCA, 12 patients in LAD and 8 patients in LCX. Coronary artery spasm of 2 sites was observed in 11 patients. In 27 patients, typical chest pain was developed with spasm. The ECG changes during spasm were ST elevation in 19 patients, ST depression in 3 patients, T wave change only in 2 patients and no change in 9 patients. The provocation tests showed focal spasm in 23 patients(70%) and diffuse spasm in 10 patients(30%). CONCLUSION: Intracoronary ergonovine provocation test appears to be a safe and effective method to provoke the coronary artery spasm.

Vasospastic Angina with Clinical Presentation of Unstable Angina in Korea:Prospective Study with Ergonovine Echocardiography

BACKGROUND: Two dimensional echocardiographic monitoring of left ventricular resional wall motion abnormalities(RWMA) with incremental injection of ergonovine up to 350microg(ErgEcho) is useful for a noninvasive diagnosis of coronary vasospasm(CVS). The prevalence that CVS may evoke unstable angina(UA). However, this theory has not been the subject of any systematic analysis to date. This prospective study was carried out on patients who had been tentatively diagnosed as having UA when they were carried out on patients who has been tentatively diagnosed as having UA when they were admitted to the coronary care unit due to chest pain. The aim was to determine the significance of CVS in the clinical spectrum of UA and the value of Erg Echo when applied to this situation. METHODS: With antianginal medications a diagnostic coronary angiography was done to rule out significant fixed athrosclerotic disease(FD), with more than 70% narrowing of luminal diameter. In patients with normal coronary angiograms of insignificant FD. Erg Echo was performed to diagnose CVS after the discontinuation of all antianginal medications. All patients with postinfarction or secondary angina were excluded in this study. RESULTS: Of 191 patients(135 males, 57+/-9 yrs) enrolled from Mar 1992 to June 1993,71%(135/191) showed significant FD in the angiography. CVS was documented in 18%(34/191) using Erg Echo with mean injected ergonovine dosage of 125+/-89microg. In patients with CVS only 24%(8/34) had mild fixed lesion in the angiography with mean luminal narrowing of 60%(+/-12%). RWMA in the territory of left anterior descending artery was the most common(70%, 24/34). Other causes of chest were esophageal spasm in 3 patient(1%, 3/191) and hypertrophic cardiomyopathy in 2 patients, and 17 patients were diagnosed as having chest pain of unkwnon etiology. One of them redeveloped chest pain 2 months later. when repeated Erg Echo revealed RWMA. Others were symptom free during the follow-up(8+/-4 months) and there were no cardiac events. CONCLUSION: Our data suggest that in patients presenting UA in Korea, CVA is the main cause of myocardial ischemia in considerable number of patient, and Erg Echo after the angiography is useful and safe for noninvasive diagnosis of CVS in this situation.